Pamela Tsing MD, Sue Nahm MA MPhil
Confidence and Preparation: Informing USMLE Step 2 Clinical Knowledge Exam Study Strategies
The USMLE Step 1 and Step 2 CK exams, typically taken at the end of the second year and in the fourth year of medical school, respectively, are central to medical licensure and the residency match process. Traditionally, Step 1 has played a more significant role than the Step 2 CK exam in the residency match process, particularly as it relates to a student’s prospects of securing an interview (1). As Step 1 transitions to pass/fail in 2022, the Step 2 CK exam score will become a more valuable tool for residency programs in evaluating applicants (2). It is anticipated that these programs will put increased weight on the Step 2 CK exam score. Students vary widely in their approach to studying for the Step 2 CK exam and there has been little data demonstrating approaches or tools that are effective for students preparing for the exam. With the elimination of a score for Step 1, there is now a need to identify evidence-based study strategies to help students prepare for the Step 2 CK exam.
We distributed post-exam surveys to all second year and fourth year students at the David Geffen School of Medicine at UCLA within 1 month of receiving their exam score on the USMLE Step 1 or Step 2 CK exam, respectively (as applicable). Survey participation was optional. Data described in this study reflects the cohort of students who completed the Step 1 exam in 2019 and the Step 2 CK exam in 2020/2021.
Students were asked a mix of multiple choice and open-ended questions related to specialty interests, study schedules, and resources used. In addition, students were asked to subjectively report their feelings of “exam preparedness” and “score satisfaction” for both the Step 1 and Step 2 CK exam, and to compare their feelings of exam preparedness and score satisfaction between both exams using a 5-point scale, where 5 indicated feeling significantly more prepared or satisfied with Step 2 CK compared to Step 1, and 1 indicated feeling significantly more prepared or satisfied with Step 1 compared to Step 2 CK.
A total of 119 students completed the Step 1 exam survey in 2019. Of these students, the largest group of students reported taking 6 weeks for a dedicated study period (n=41) and reported studying 10-12 hours per day during their dedicated time (n=41). Most students (n=102) started studying prior to the start of their dedicated study period; however only 16 students started studying prior to the start of the second year of medical school. One hundred and twenty students completed the Step 2 CK survey in 2020/2021 after receiving their exam score. Of these students, 80 indicated feeling more prepared for Step 2 CK compared to Step 1. For Step 2 CK, only 51% of students started studying prior to starting dedicated, and the largest group (43 students, 37%) spent 3 weeks or fewer in their dedicated.
The USMLE Step 2 CK exam is a capstone of clinical education and an increasingly important component of residency program applications as we transition to a pass/fail Step 1 exam. In our study, we found logitudinal factors heped students prepare for their exam. Many students indicated that clinical clerkships and the preparation required for shelf exams throughout third-year helped them succeed on the Step 2 CK exam. Additionally, we found that students who completed the entire UWorld question bank as part of Step 2 CK studying tended to feel more confident for their Step 2 exam (p =0.002). Small-scale factors, such as hours studied per day, did not have any statistically significant impact on Step 2 CK confidence. We hope that by comparing trends on study strategies we can help guide individual approaches and institutional recommendations for Step 2 CK exam preparation.
Kremer TR, Kremer MJ, Kremer KP, Mihalic A. Predictors of getting a residency interview: Differences by medical specialty [published online ahead of print, 2020 Aug 4]. Med Educ. 2020;10.1111/medu.14303. doi:10.1111/medu.14303
Choudhary A, Makhoul AT, Ganesh Kumar N, Drolet BC. Impact of Pass/Fail USMLE Step 1 Scoring on the Internal Medicine Residency Application Process: a Program Director Survey [published online ahead of print, 2020 Jun 30]. J Gen Intern Med. 2020;10.1007/s11606-020-05984-y. doi:10.1007/s11606-020-05984-y